Pressure Injury Risk Assessment and Associations in an Adult Inpatient Rehabilitation Sample- Retrospective Cohort Study

Research Objectives: To identify risk factors for the development of Hospital Acquired Pressure Injury (HAPI) over 6 months in an Inpatient Rehabilitation Facility (IRF) using the Braden Scale for Pressure Injury Prevention (Braden) and other variables.

Design: Observational Retrospective Cohort Study

Setting: 262 bed free-standing IRF at an urban academic medical center

Participants: Adults 18 years and older admitted to IRF from July through December 2020 were included.

Interventions: n/a

Main Outcome Measures: Logistic regression is used to assess HAPI occurrence during episode of care, against possible predictors including the Braden total score, Braden subscales, demographics, lab albumen, pain, diagnosis-related impairment group, external medical/orthopedic devices, expression of ideas/wants and understanding of verbal content.

Results: Of 1342 unique patients with 1494 episode of care, 54 (3.6%) HAPI events occurred. Before adjustment, Braden total score of 15 (14.69, SD 1.92) and below was associated with increased HAPI occurrence (p < 0.001).

Univariate analyses identified the following significant risk factors for HAPI: age, impairment group, gastrointestinal tube, urinary catheter, expression of ideas/wants and understanding of verbal content. After adjusting for these variables, each one-point increase was associated with a 23% reduced odds of HAPI occurrence (95% CI, 0.65-0.90; p< 0.001). Three variables were still strongly associated with increased HAPI occurrence: Braden subscale “Friction/Shear” (OR 0.47; 95%CI, 0.27-0.81; p< 0.007), presence of a gastrointestinal tube (OR 2.51 higher odds; 95%CI, 1.03-5.66; p< 0.001), and rarely/never expresses ideas/wants (OR 9.16 higher odds; 95%CI, 0.94-70.05; p< 0.04) compared to no difficulty.

Impairment group modified the effects: People with Spinal Cord Injury (SCI) had a greater odds of HAPI occurrence compared to those with Brain (OR 0.28; 95% CI, 0.11-0.66; p< 0.001) and Medically Complex (OR 0.31; 95% CI, 0.15-0.63; p< 0.001) impairments.

Conclusions: This study builds on prior SCI-related Braden research by including all patients admitted to IRF. Clinicians should consider adult IRF patients at risk for HAPI with Braden total scores of 15 and below, worse problems of “Friction/Shear”, presence of a gastrointestinal tube, and patient’s inability to express ideas/wants.

Author(s) Disclosures: n/a